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Hohenschurz-Schmidt D, Phalip J, Chan J, Gauhe G, Soliman N, Vollert J, Lunde SJ, Vase L. Placebo analgesia in physical and psychological interventions: Systematic review and meta-analysis of three-armed trials. Eur J Pain 2024; 28:513-531. [PMID: 37985188 DOI: 10.1002/ejp.2205] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/18/2023] [Accepted: 11/03/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND The magnitude of placebo effects from physical and psychological 'sham' is unknown but could impact efficacy trials and treatment understanding. To quantify placebo effects, this systematic review of three-armed randomised controlled trials (RCTs) of physical and psychological interventions for pain compared outcomes in 'sham' control intervention and non-exposure arms. METHODS RCTs with treatment, 'sham' control intervention, and non-exposure groups were included, enrolling adults with any pain. A protocol was pre-registered (PROSPERO: CRD42023413324), and twelve databases searched from 2008 to July 2023. Trial methods and blinding were analysed descriptively and risk of bias assessed. Meta-analysis of pain measures at short-, medium- and long-term was performed with random-effects models of standardised mean differences (SMD).Studies were sub-grouped according to control intervention type. RESULTS Seventeen RCTs were included. The average short-term placebo effect was small (0.21 SMD, 0.1-0.33 95% CI, p = 0.0002, 1440 participants). It showed no heterogeneity (Tau2 = 0.1, I2 = 11%, p = 0.3), preventing meta-regression analyses of effect modifiers. However, sub-group analyses revealed larger placebo effects in manual control interventions compared to disabled devices and miscellaneous control interventions. Overall, placebo analgesia accounted for 39% of treatments' short-term effectiveness. No placebo effects were found at medium-term (7 RCTs, 381 participants) or long-term follow-up (3 RCTs, 173 participants). CONCLUSIONS The observed placebo analgesia has mechanistic and methodological implications, though its clinical importance may be limited. Control intervention design affects placebo effects, highlighting the importance of considering methodology in RCT interpretation. Review limitations include a small number of long-term studies and sample heterogeneity. SIGNIFICANCE This systematic review directly quantifies placebo effects from physical and psychological 'sham' control interventions and compares them to treatments' overall effectiveness. By doing so, the review enhances our understanding of placebo effects, their relative contribution in clinical trials, and their susceptibly to trial design. It poses further questions regarding the influence of blinding, participant expectations, and features of the therapeutic context. Overall, the insights provided by this review carry methodological significance and are important for the interpretation and synthesis of efficacy trials in this field.
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Affiliation(s)
- David Hohenschurz-Schmidt
- Pain Research, Department of Surgery and Cancer, Imperial College London, London, UK
- Research Department, University College of Osteopathy, London, UK
| | - Jules Phalip
- Institut ANALGESIA, Faculté de Médecine, Université Clermont Auvergne, Clermont-Ferrand, France
- CHU Clermont-Ferrand, Inserm 1107 Neuro-Dol, Service de pharmacologie médicale, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Jessica Chan
- Faculty of Medicine, Imperial College London, London, UK
| | - Greta Gauhe
- Centre for Dance Research, Coventry University, Coventry, UK
| | - Nadia Soliman
- Pain Research, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jan Vollert
- Pain Research, Department of Surgery and Cancer, Imperial College London, London, UK
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Kiel, Germany
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Münster, Germany
- Neurophysiology, Mannheim Center of Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Sigrid Juhl Lunde
- Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Lene Vase
- Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
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2
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Perreault T, Arendt-Nielson L, Fernández-de-las-Peñas C, Dommerholt J, Herrero P, Hubbard R. Intramuscular Electrical Stimulation for the Treatment of Trigger Points in Patients with Chronic Migraine: A Protocol for a Pilot Study Using a Single-Case Experimental Design. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1380. [PMID: 37629671 PMCID: PMC10456716 DOI: 10.3390/medicina59081380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 07/25/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: Trigger points (TrPs) are prevalent in patients with migraine headaches. Needling interventions targeting TrPs in migraine patients may reduce the intensity and frequency of headaches, yet systematic reviews reveal a lack of robust evidence. Intramuscular electrical stimulation (IMES) is a modality that delivers electrical current into muscles and TrPs, with recent studies suggesting it may amplify the therapeutic effects of dry needling peripherally and centrally. This could be advantageous for patients with migraine and symptomatic TrPs. Materials and Methods: This study will implement a multiple baseline single-case experimental design (SCED). In a clinical setting, a SCED study lends itself to conducting research with only a few patients that each serve as their own controls. In this SCED study, four participants with chronic migraine will be enrolled in a non-concurrent manner and randomized to one of four baseline measurement periods (4, 5, 6 or 7 weeks), leading to four potentially different start dates for each participant in the intervention phase. During the intervention phase, patients will receive five sessions of dry needling with IMES, one session per week for five weeks. The primary outcome measure will be headache frequency, i.e., the reduction in the number of headache days over a one-month period using electronic headache diary data from the Migraine Buddy smartphone application. Secondary outcome measures will be changes in mean migraine pain intensity using a numeric pain rating scale (NPRS), migraine disability using the Migraine Disability Assessment Test (MIDAS), the Headache Impact Test (HIT-6), and changes in selected cervical musculoskeletal impairments including pressure pain thresholds (PPTs) over TrPs, the craniocervical flexion test (CCFT), and cervical active range of motion (AROM). Primary and secondary outcome measures will be analyzed separately using both visual and statistical analyses. Results: Actively recruiting participants. This project was approved by the Mass General Brigham Institutional Review Board (protocol #2023P000931) and is registered with ClinicalTrials.gov (NCT05893914). Conclusions: This study will seek to determine the effects of a five-week intervention period of IMES to TrPs in the posterior cervical muscles of subjects with chronic migraine.
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Affiliation(s)
- Thomas Perreault
- Department of Physical Therapy, Wentworth Douglass Hospital, Dover, NH 03820, USA;
| | - Lars Arendt-Nielson
- Center for Neuroplasticity and Pain, SMI, School of Medicine, Aalborg University, DK-9220 Aalborg, Denmark; (L.A.-N.); (C.F.-d.-l.-P.)
- Department of Gastroenterology & Hepatology, Mech-Sense, Clinical Institute, Aalborg University Hospital, DK-9000 Aalborg, Denmark
- Steno Diabetes Center North Denmark, Clinical Institute, Aalborg University Hospital, DK-9000 Aalborg, Denmark
| | - César Fernández-de-las-Peñas
- Center for Neuroplasticity and Pain, SMI, School of Medicine, Aalborg University, DK-9220 Aalborg, Denmark; (L.A.-N.); (C.F.-d.-l.-P.)
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Madrid, Spain
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia-Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, 28922 Madrid, Spain
| | - Jan Dommerholt
- Myopain Seminars, Bethesda, MD 20814, USA;
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, MD 21201, USA
| | - Pablo Herrero
- IIS Aragon, Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, 50009 Zaragoza, Spain;
| | - Ryan Hubbard
- Department of Physical Therapy, Wentworth Douglass Hospital, Dover, NH 03820, USA;
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3
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Hohenschurz-Schmidt DJ, Cherkin D, Rice AS, Dworkin RH, Turk DC, McDermott MP, Bair MJ, DeBar LL, Edwards RR, Farrar JT, Kerns RD, Markman JD, Rowbotham MC, Sherman KJ, Wasan AD, Cowan P, Desjardins P, Ferguson M, Freeman R, Gewandter JS, Gilron I, Grol-Prokopczyk H, Hertz SH, Iyengar S, Kamp C, Karp BI, Kleykamp BA, Loeser JD, Mackey S, Malamut R, McNicol E, Patel KV, Sandbrink F, Schmader K, Simon L, Steiner DJ, Veasley C, Vollert J. Research objectives and general considerations for pragmatic clinical trials of pain treatments: IMMPACT statement. Pain 2023; 164:1457-1472. [PMID: 36943273 PMCID: PMC10281023 DOI: 10.1097/j.pain.0000000000002888] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 01/09/2023] [Accepted: 01/12/2023] [Indexed: 03/23/2023]
Abstract
ABSTRACT Many questions regarding the clinical management of people experiencing pain and related health policy decision-making may best be answered by pragmatic controlled trials. To generate clinically relevant and widely applicable findings, such trials aim to reproduce elements of routine clinical care or are embedded within clinical workflows. In contrast with traditional efficacy trials, pragmatic trials are intended to address a broader set of external validity questions critical for stakeholders (clinicians, healthcare leaders, policymakers, insurers, and patients) in considering the adoption and use of evidence-based treatments in daily clinical care. This article summarizes methodological considerations for pragmatic trials, mainly concerning methods of fundamental importance to the internal validity of trials. The relationship between these methods and common pragmatic trials methods and goals is considered, recognizing that the resulting trial designs are highly dependent on the specific research question under investigation. The basis of this statement was an Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) systematic review of methods and a consensus meeting. The meeting was organized by the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION) public-private partnership. The consensus process was informed by expert presentations, panel and consensus discussions, and a preparatory systematic review. In the context of pragmatic trials of pain treatments, we present fundamental considerations for the planning phase of pragmatic trials, including the specification of trial objectives, the selection of adequate designs, and methods to enhance internal validity while maintaining the ability to answer pragmatic research questions.
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Affiliation(s)
- David J. Hohenschurz-Schmidt
- Pain Research, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Dan Cherkin
- Department of Family Medicine, University of Washington and Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Andrew S.C. Rice
- Pain Research, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Robert H. Dworkin
- Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Dennis C. Turk
- Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States
| | - Michael P. McDermott
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, United States
| | - Matthew J. Bair
- VA Center for Health Information and Communication, Regenstrief Institute, and Indiana University School of Medicine, Indianapolis, IN, United States
| | - Lynn L. DeBar
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | | | - John T. Farrar
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, United States
| | - Robert D. Kerns
- Departments of Psychiatry, Neurology and Psychology, Yale University, New Haven, CT, United States
| | - John D. Markman
- Neuromedicine Pain Management and Translational Pain Research, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Michael C. Rowbotham
- Department of Anesthesia, University of California San Francisco School of Medicine, San Francisco, CA, United States
| | - Karen J. Sherman
- Kaiser Permanente Washington Health Research Institute and Department of Epidemiology, University of Washington, Seattle WA, United States
| | - Ajay D. Wasan
- Departments of Anesthesiology & Perioperative Medicine, and Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Penney Cowan
- American Chronic Pain Association, Rocklin, CA, United States
| | - Paul Desjardins
- Department of Diagnostic Sciences, School of Dental Medicine, Rutgers University, Newark, NJ, United States
| | - McKenzie Ferguson
- Department of Pharmacy Practice, Southern Illinois University Edwardsville, Edwardsville, IL, United States
| | - Roy Freeman
- Department of Neurology, Harvard Medical School, Boston, MA, United States
| | - Jennifer S. Gewandter
- Department of Anesthesiology and Perioperative, University of Rochester, Rochester, NY, United States
| | - Ian Gilron
- Departments of Anesthesiology & Perioperative Medicine, Biomedical & Molecular Sciences, Centre for Neuroscience Studies, and School of Policy Studies, Queen's University, Kingston, ON, Canada
| | - Hanna Grol-Prokopczyk
- Department of Sociology, University at Buffalo, State University of New York, Buffalo NY, United States
| | - Sharon H. Hertz
- Hertz and Fields Consulting, Inc, Silver Spring, MD, United States
| | | | - Cornelia Kamp
- Center for Health and Technology (CHeT), Clinical Materials Services Unit (CMSU), University of Rochester Medical Center, Rochester, NY, United States
| | | | - Bethea A. Kleykamp
- Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - John D. Loeser
- Departments of Neurological Surgery and Anesthesia and Pain Medicine, University of Washington, Seattle, WA, United States
| | - Sean Mackey
- Department of Anesthesiology, Perioperative, and Pain Medicine, Neurosciences and Neurology, Stanford University School of Medicine, Palo Alto, CA, United States
| | | | - Ewan McNicol
- Department of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences, Boston, MA, United States
| | - Kushang V. Patel
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States
| | - Friedhelm Sandbrink
- Department of Neurology, Washington DC Veterans Affairs Medical Center, Washington, DC, United States
- Department of Neurology, George Washington University, Washington, DC, United States
| | - Kenneth Schmader
- Department of Medicine-Geriatrics, Center for the Study of Aging, Duke University Medical Center, and Geriatrics Research Education and Clinical Center, Durham VA Medical Center, Durham, NC, United States
| | - Lee Simon
- SDG, LLC, Cambridge, MA, United States
| | | | - Christin Veasley
- Chronic Pain Research Alliance, North Kingstown, RI, United States
| | - Jan Vollert
- Pain Research, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
- Neurophysiology, Mannheim Center of Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
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4
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Byrne A, Lodge C, Wallace J. Design and testing the validity of an inexpensive and accessible sham dry needling protocol. J Bodyw Mov Ther 2023; 35:169-174. [PMID: 37330765 DOI: 10.1016/j.jbmt.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 10/12/2022] [Accepted: 04/11/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE To use a simple method of needle blunting to produce a placebo dry needling protocol which is indistinguishable from the sensations felt during therapeutic dry needling. METHODS A randomised cross-over design was used to compare the perception of needle skin penetration, pain experienced and types of sensations experienced following a single placebo dry needling and a single therapeutic dry needling application. RESULTS There were no significant differences in the proportions of patients reported ability to perceive needle penetration (p = 0.646), description of needling sensations (p = 0.3) or pain rating (p = 0.405) when comparing placebo needling to therapeutic dry needling. CONCLUSION Needle tip bending creates a simple, cost-effective and effective placebo needle for use in comparisons with therapeutic dry needling. This offers researchers a viable alternative to expensive and inappropriate acupuncture sham devices when conducting dry needling trials.
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Affiliation(s)
- A Byrne
- Department of Health and Sport Sciences, South East Technological University, Carlow, Ireland.
| | - C Lodge
- Department of Health and Sport Sciences, South East Technological University, Carlow, Ireland.
| | - J Wallace
- Department of Health and Sport Sciences, South East Technological University, Carlow, Ireland
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5
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Hohenschurz-Schmidt D, Vase L, Scott W, Annoni M, Ajayi OK, Barth J, Bennell K, Berna C, Bialosky J, Braithwaite F, Finnerup NB, Williams ACDC, Carlino E, Cerritelli F, Chaibi A, Cherkin D, Colloca L, Côté P, Darnall BD, Evans R, Fabre L, Faria V, French S, Gerger H, Häuser W, Hinman RS, Ho D, Janssens T, Jensen K, Johnston C, Juhl Lunde S, Keefe F, Kerns RD, Koechlin H, Kongsted A, Michener LA, Moerman DE, Musial F, Newell D, Nicholas M, Palermo TM, Palermo S, Peerdeman KJ, Pogatzki-Zahn EM, Puhl AA, Roberts L, Rossettini G, Tomczak Matthiesen S, Underwood M, Vaucher P, Vollert J, Wartolowska K, Weimer K, Werner CP, Rice ASC, Draper-Rodi J. Recommendations for the development, implementation, and reporting of control interventions in efficacy and mechanistic trials of physical, psychological, and self-management therapies: the CoPPS Statement. BMJ 2023; 381:e072108. [PMID: 37230508 DOI: 10.1136/bmj-2022-072108] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- David Hohenschurz-Schmidt
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Research Department, University College of Osteopathy, London, UK
| | - Lene Vase
- Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, Denmark
| | - Whitney Scott
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London; INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Marco Annoni
- Italian National Research Council, Interdepartmental Centre for Research Ethics and Integrity, Rome, Italy
| | - Oluwafemi K Ajayi
- Department of Arts and Music, College of Human Sciences, University of South Africa, Pretoria, South Africa
| | - Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Switzerland
| | - Kim Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, VIC, Australia
| | - Chantal Berna
- Centrer for Integrative and Complementary Medicine, Pain Center, Division of Anesthesiology, Sense Institute, Lausanne University Hospital, Lausanne University, Lausanne, Switzerland
| | - Joel Bialosky
- Department of Physical Therapy, University of Florida, Gainesville FL, USA; Brooks-PHHP Research Collaboration, Jacksonville, FL, USA
| | | | - Nanna B Finnerup
- Danish Pain Research Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Amanda C de C Williams
- Research Department of Clinical, Educational & Health Psychology, University College London, London, UK
| | - Elisa Carlino
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Turin, Italy
| | | | - Aleksander Chaibi
- Department for Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Dan Cherkin
- Osher Center for Integrative Health, Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Luana Colloca
- Department of Pain and Translational Symptom Science, School of Nursing; Department of Anesthesiology, School of Medicine; University of Maryland, Baltimore, MD, USA
| | - Pierre Côté
- Faculty of Health Sciences, Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, ON, Canada
| | - Beth D Darnall
- Stanford Pain Relief Innovations Lab; Stanford University School of Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford, CA, USA
| | - Roni Evans
- Integrative Health & Wellbeing Research Program; Center for Spirituality and Healing, University of Minnesota, Minneapolis, MN, USA
| | - Laurent Fabre
- Centre Européen d'Enseignement Supérieur de l'Ostéopathie, Paris, France
| | - Vanda Faria
- Department of Psychology, Uppsala University, Uppsala, Sweden; Smell & Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany; Brain and Eye Pain Imaging Lab, Pain and Affective Neuroscience Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Simon French
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, NSW, Australia
| | - Heike Gerger
- Erasmus MC, University Medical Centre Rotterdam, Department of General Practice, Rotterdam, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Winfried Häuser
- Department Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany
| | - Rana S Hinman
- Centre for Health, Exercise & Sports Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Dien Ho
- Center for Health Humanities, School of Arts and Sciences, Massachusetts College of Pharmacy and Health Sciences, Boston MA, USA
| | - Thomas Janssens
- Health Psychology, KU Leuven; Ebpracticenet, Leuven, Belgium
| | - Karin Jensen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Chris Johnston
- BC Patient Safety & Quality Council's Patient Voices Network; Health Research BC's Partnership-Ready Network; Health Standards Organization's Emergency Management Technical Committee & Working Group
| | - Sigrid Juhl Lunde
- Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, Denmark
| | - Francis Keefe
- Duke University, School of Medicine, Durham, NC, USA
| | - Robert D Kerns
- Departments of Psychiatry, Neurology, and Psychology, Yale University, New Haven, CT, USA
| | - Helen Koechlin
- Division of Psychosomatics and Psychiatry, University Children's Hospital Zurich; Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland; Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Chiropractic Knowledge Hub, Odense, Denmark
| | - Lori A Michener
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles CA, USA
| | - Daniel E Moerman
- College of Arts, Sciences, and Letters, Behavioral Sciences, University of Michigan, Dearborn, MI, USA
| | - Frauke Musial
- National Research Centre in Complementary and Alternative Medicine, Department of Community Medicine, Faculty of Health Science UiT, Arctic University of Norway, Tromsø, Norway
| | | | - Michael Nicholas
- Pain Management Research Institute, University of Sydney Medical School (Northern) and Kolling Institute of Medical Research at Royal North Shore Hospital, Sydney, Australia
| | - Tonya M Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Sara Palermo
- Diagnostic and Technology Department, Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Department of Psychology, University of Turin, Turin, Italy
| | - Kaya J Peerdeman
- Unit Health, Medical and Neuropsychology, Leiden University, Leiden, the Netherlands
| | - Esther M Pogatzki-Zahn
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | | | - Lisa Roberts
- University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Giacomo Rossettini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Campus of Savona, Savona, Italy; School of Physiotherapy, University of Verona, Verona, Italy
| | - Susan Tomczak Matthiesen
- Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, Denmark
| | - Martin Underwood
- Warwick Clinical Trials Unit; University of Warwick, Coventry, UK; University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Paul Vaucher
- School of Health Sciences Fribourg, HES-SO University of Applied Sciences and Arts Western Switzerland, Switzerland
| | - Jan Vollert
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany; Neurophysiology, Mannheim Centre of Translational Neuroscience, Medical Faculty Mannheim, Heidelberg University, Germany; Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Germany
| | - Karolina Wartolowska
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Katja Weimer
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Centre, Ulm, Germany
| | - Christoph Patrick Werner
- School of Psychology, Faculty of Science, University of Sydney, Australia; Department of Clinical Research, University Hospital Basel, Switzerland
| | - Andrew S C Rice
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Jerry Draper-Rodi
- Research Department, University College of Osteopathy, London, UK
- National Council for Osteopathic Research, London, UK
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6
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Hohenschurz-Schmidt D, Draper-Rodi J, Vase L, Scott W, McGregor A, Soliman N, MacMillan A, Olivier A, Cherian CA, Corcoran D, Abbey H, Freigang S, Chan J, Phalip J, Sørensen LN, Delafin M, Baptista M, Medforth NR, Ruffini N, Andresen SS, Ytier S, Ali D, Hobday H, Ngurah Agung Adhiyoga Santosa AA, Vollert J, Rice AS. Blinding and sham control methods in trials of physical, psychological, and self-management interventions for pain (article II): a meta-analysis relating methods to trial results. Pain 2023; 164:509-533. [PMID: 36271798 PMCID: PMC9916063 DOI: 10.1097/j.pain.0000000000002730] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 05/16/2022] [Accepted: 06/25/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT Sham interventions in randomized clinical trials (RCTs) of physical, psychological, and self-management (PPS) therapies for pain are highly variable in design and believed to contribute to poor internal validity. However, it has not been formally tested whether the extent to which sham controls resemble the treatment under investigation consistently affects trial outcomes, such as effect sizes, differential attrition, participant expectancy, and blinding effectiveness. Placebo- or sham-controlled RCTs of PPS interventions of clinical pain populations were searched in 12 databases. The similarity of control interventions to the experimental treatment was rated across 25 features. Meta-regression analyses assessed putative links between employed control interventions, observed effect sizes in pain-related outcomes, attrition, and blinding success. The sample included 198 unique control interventions, dominated by manual therapy and chronic musculoskeletal pain research. Meta-analyses indicated small-to-moderate benefits of active treatments over control interventions, across subgroups of manual therapies, exercise, and rehabilitation, and psychological intervention trials. Multiple meta-regression modelling demonstrated that similarity between sham control and tested interventions predicted variability in pain-related outcomes, attrition, and blinding effectiveness. Influential variables were differences relating to the extent of intervention exposure, participant experience, and treatment environments. The results support the supposed link between blinding methods and effect sizes, based on a large and systematically sourced overview of methods. However, challenges to effective blinding are complex and often difficult to discern from trial reports. Nonetheless, these insights have the potential to change trial design, conduct, and reporting and will inform guideline development.
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Affiliation(s)
- David Hohenschurz-Schmidt
- Pain Research, Department Surgery & Cancer, Faculty of Medicine, Imperial College, London, United Kingdom
| | - Jerry Draper-Rodi
- Research Centre, University College of Osteopathy, London, United Kingdom
| | - Lene Vase
- Department of Psychology and Behavioural Sciences, Section for Psychology and Neuroscience, Aarhus University, Aarhus, Denmark
| | - Whitney Scott
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Alison McGregor
- Human Performance Group, Department Surgery & Cancer, Faculty of Medicine, Imperial College, London, United Kingdom
| | - Nadia Soliman
- Pain Research, Department Surgery & Cancer, Faculty of Medicine, Imperial College, London, United Kingdom
| | - Andrew MacMillan
- Research Centre, University College of Osteopathy, London, United Kingdom
| | - Axel Olivier
- Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Cybill Ann Cherian
- Chemical Engineering Department, Khalifa University, Abu Dhabi, United Arab Emirates
| | | | - Hilary Abbey
- Research Centre, University College of Osteopathy, London, United Kingdom
| | - Sascha Freigang
- Department of Neurosurgery, Medical University Graz, Graz, Austria
| | - Jessica Chan
- Faculty of Medicine, Imperial College London, London, United Kingdom
| | | | - Lea Nørgaard Sørensen
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Maite Delafin
- The Penn Clinic, Hertfordshire, Hatfield, United Kingdom
| | - Margarida Baptista
- Wolfson Centre for Age Related Diseases, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | | | - Nuria Ruffini
- National Centre Germany, Foundation C.O.M.E. Collaboration, Berlin, Germany
| | | | | | - Dorota Ali
- Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Harriet Hobday
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | | | - Jan Vollert
- Pain Research, Department Surgery & Cancer, Faculty of Medicine, Imperial College, London, United Kingdom
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Münster,Germany
- Neurophysiology, Mannheim Center of Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Andrew S.C. Rice
- Pain Research, Department Surgery & Cancer, Faculty of Medicine, Imperial College, London, United Kingdom
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7
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Hohenschurz-Schmidt D, Draper-Rodi J, Vase L, Scott W, McGregor A, Soliman N, MacMillan A, Olivier A, Cherian CA, Corcoran D, Abbey H, Freigang S, Chan J, Phalip J, Nørgaard Sørensen L, Delafin M, Baptista M, Medforth NR, Ruffini N, Skøtt Andresen S, Ytier S, Ali D, Hobday H, Santosa AANAA, Vollert J, Rice AS. Blinding and sham control methods in trials of physical, psychological, and self-management interventions for pain (article I): a systematic review and description of methods. Pain 2023; 164:469-484. [PMID: 36265391 PMCID: PMC9916059 DOI: 10.1097/j.pain.0000000000002723] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 05/17/2022] [Accepted: 06/12/2022] [Indexed: 11/25/2022]
Abstract
ABSTRACT Blinding is challenging in randomised controlled trials of physical, psychological, and self-management therapies for pain, mainly because of their complex and participatory nature. To develop standards for the design, implementation, and reporting of control interventions in efficacy and mechanistic trials, a systematic overview of currently used sham interventions and other blinding methods was required. Twelve databases were searched for placebo or sham-controlled randomised clinical trials of physical, psychological, and self-management treatments in a clinical pain population. Screening and data extraction were performed in duplicate, and trial features, description of control methods, and their similarity to the active intervention under investigation were extracted (protocol registration ID: CRD42020206590). The review included 198 unique control interventions, published between 2008 and December 2021. Most trials studied people with chronic pain, and more than half were manual therapy trials. The described control interventions ranged from clearly modelled based on the active treatment to largely dissimilar control interventions. Similarity between control and active interventions was more frequent for certain aspects (eg, duration and frequency of treatments) than others (eg, physical treatment procedures and patient sensory experiences). We also provide an overview of additional, potentially useful methods to enhance blinding, as well as the reporting of processes involved in developing control interventions. A comprehensive picture of prevalent blinding methods is provided, including a detailed assessment of the resemblance between active and control interventions. These findings can inform future developments of control interventions in efficacy and mechanistic trials and best-practice recommendations.
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Affiliation(s)
- David Hohenschurz-Schmidt
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea, London, United Kingdom
| | - Jerry Draper-Rodi
- Research Centre, University College of Osteopathy, London, United Kingdom
| | - Lene Vase
- Section for Psychology and Neuroscience, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus C, Denmark
| | - Whitney Scott
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Alison McGregor
- Human Performance Group, Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, United Kingdom
| | - Nadia Soliman
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea, London, United Kingdom
| | - Andrew MacMillan
- Research Centre, University College of Osteopathy, London, United Kingdom
| | - Axel Olivier
- Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Cybill Ann Cherian
- Chemical Engineering Department, Khalifa University, Abu Dhabi, United Arab Emirates
| | | | - Hilary Abbey
- Research Centre, University College of Osteopathy, London, United Kingdom
| | - Sascha Freigang
- Department of Neurosurgery, Medical University Graz, Graz, Austria
| | - Jessica Chan
- Faculty of Medicine, Imperial College London, London, United Kingdom
| | | | - Lea Nørgaard Sørensen
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Maite Delafin
- The Penn Clinic, Hertfordshire, Hatfield, United Kingdom
| | - Margarida Baptista
- Department of Psychology, Wolfson Centre for Age Related Diseases, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | | | - Nuria Ruffini
- National Centre Germany, Foundation C.O.M.E. Collaboration, Berlin, Germany
| | | | | | - Dorota Ali
- Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Harriet Hobday
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | | | - Jan Vollert
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea, London, United Kingdom
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital of Schleswig-Holstein, Kiel, Germany
- Neurophysiology, Mannheim Center of Translational Neuroscience (MCTN), Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Andrew S.C. Rice
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College, Chelsea, London, United Kingdom
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8
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Chys M, De Meulemeester K, De Greef I, Murillo C, Kindt W, Kouzouz Y, Lescroart B, Cagnie B. Clinical Effectiveness of Dry Needling in Patients with Musculoskeletal Pain-An Umbrella Review. J Clin Med 2023; 12:jcm12031205. [PMID: 36769852 PMCID: PMC9917679 DOI: 10.3390/jcm12031205] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 02/05/2023] Open
Abstract
The number of systematic reviews (SR) summarizing the literature regarding the clinical effects of Dry Needling (DN) has increased rapidly. Yet, rigorous evidence about the clinical effectiveness of this technique is still lacking. The aim of this umbrella review is to summarize the evidence about the clinical effects of trigger point DN on musculoskeletal disorders across all body regions. PubMed, Web of Science and Embase were searched to identify SRs examining the effect of DN (as a stand-alone intervention or combined with another treatment modality) compared to sham/no intervention or a physical therapy (PT) intervention with at least one clinical outcome in the domain of pain or physical functioning. Risk of bias (RoB) was assessed with the AMSTAR-2 tool. Quantification of the overlap in primary studies was calculated using the corrected covered area (CCA). The electronic search yielded 2286 results, of which 36 SRs were included in this review. Overall, DN is superior to sham/no intervention and equally effective to other interventions for pain reduction at short-term regardless of the body region. Some SRs favored wet needling (WN) over DN for short-term pain reductions. Results on physical functioning outcomes were contradictory across body regions. Limited data is available for mid- and long-term effects. DN has a short-term analgesic effect in all body regions and may be of additional value to the interventions that are used to date in clinical practice. Several studies have shown an additional treatment effect when combining DN to physiotherapeutic interventions compared to these interventions in isolation. There is a substantial need for the standardization of DN protocols to address the problem of heterogeneity and to strengthen the current evidence.
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Affiliation(s)
- Marjolein Chys
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
- Correspondence:
| | | | - Indra De Greef
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
| | - Carlos Murillo
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
- Pain in Motion International Research Group, 1000 Brussels, Belgium
| | - Wouter Kindt
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
| | - Yassir Kouzouz
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
| | - Bavo Lescroart
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
| | - Barbara Cagnie
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
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9
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Chys M, Bontinck J, Voogt L, Sendarrubias GMG, Cagnie B, Meeus M, De Meulemeester K. Immediate effects of dry needling on pain sensitivity and pain modulation in patients with chronic idiopathic neck pain: a single-blinded randomized clinical trial. Braz J Phys Ther 2023; 27:100481. [PMID: 36709694 PMCID: PMC9894914 DOI: 10.1016/j.bjpt.2023.100481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 11/10/2022] [Accepted: 12/21/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Dry needling is frequently used for the treatment of neck pain but knowledge about its neurophysiological central effects is scarce. OBJECTIVES To compare the immediate effects of a single session of dry needling (DN) and sham needling (SN) on local and distant pressure pain thresholds and conditioned pain modulation in patients with chronic idiopathic neck pain. METHOD Participants with chronic idiopathic neck pain were randomly allocated to a DN or SN group. The primary outcome measure was the pressure pain threshold (PPT) at one peripheral location: quadriceps muscle (Q). Secondary outcome measures were local PPTs at the treated (most painful) (tUT) and non-treated upper trapezius muscle (ntUT), absolute and relative conditioned pain modulation (CPM) effects and pain during hot water immersion. Patients were assessed at baseline and immediately post intervention. Linear mixed models were used to examine interaction effects as well as between- and within-group differences. RESULTS Fifty-four participants were included for statistical analysis. Linear mixed model analyses showed no significant "group X time" interaction effects for any of the outcome measures. The relative CPM effect at the Q was significantly higher post-intervention, compared to baseline within the DN group (mean difference= 13.52%; 95% CI: 0.46, 26.59). CONCLUSION The present study shows no superior effect of DN, compared to SN, in the immediate effect on local and distant PPTs and CPM in patients with chronic idiopathic neck pain.
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Affiliation(s)
- Marjolein Chys
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, Gent 9000, Belgium.
| | - Jente Bontinck
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, Gent 9000, Belgium; Pain in Motion International Research Group, www.paininmotion.be
| | - Lennard Voogt
- Pain in Motion International Research Group, www.paininmotion.be; Research Centre for Health Care Innovations, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| | | | - Barbara Cagnie
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, Gent 9000, Belgium
| | - Mira Meeus
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, Gent 9000, Belgium; Pain in Motion International Research Group, www.paininmotion.be; Department of Rehabilitation Sciences and Physical Therapy, Faculty of Medicine and Health Sciences, MOVANT Research group, University of Antwerp, Belgium
| | - Kayleigh De Meulemeester
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, Gent 9000, Belgium; Pain in Motion International Research Group, www.paininmotion.be
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10
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Gallego-Sendarrubias GM, Voogt L, Arias-Buría JL, Braithwaite FA, Fernández-de-Las-Peñas C. Effects of previous experience with dry needling therapy on blinding effectiveness and pain outcomes in people with neck pain: A preliminary sham-controlled study. Musculoskelet Sci Pract 2022; 58:102515. [PMID: 35085999 DOI: 10.1016/j.msksp.2022.102515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 01/11/2022] [Accepted: 01/18/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Participants' previous experience with an intervention may be an important variable when conducting sham-controlled trials. OBJECTIVE This study explored if previous experience with dry needling (DN) influenced blinding effectiveness and pain outcomes, after the application of DN in patients with neck pain. DESIGN A preliminary randomized, sham-controlled study. METHODS Participants were randomized to receive a single session of real or sham DN. Previous experience with DN (yes/no) was recorded. Blinding effectiveness was assessed by asking participants to guess their group allocation (real/sham/not sure) 5 min post-intervention. Outcomes including pain intensity, pressure pain thresholds, and self-perceived improvement, were assessed by a blinded assessor at baseline, one- and seven-days post-intervention. RESULTS Of 50 patients recruited, 30 had previous experience and 20 did not. Fifty-seven percent (n = 17/30) with previous experience and 35% (n = 7/20) without experience correctly identified their group allocation, but this difference was not significant (χ2 = 2.333; P = 0.127). No interaction between previous experience and clinical outcomes were found, except that participants with previous experience receiving real DN showed greater improvements in pain during cervical rotation than those without previous experience at one (Δ -11.5 mm 95%CI -22.0 to -1.0 mm) and seven days (Δ -8.5 mm, -16.00 to -1.0 mm) post-intervention. CONCLUSIONS Participants with previous experience were 22% more accurate at identifying their group allocation than those without experience, but the difference was not significant. Previous experience did not influence most clinical outcomes, except for pain intensity after real DN. Future studies evaluating effects of previous experience of DN should include more detailed information of previous experience.
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Affiliation(s)
| | - Lennard Voogt
- Rotterdam University of Applied Sciences, Department of Physiotherapy, Rotterdam, the Netherlands
| | - José Luis Arias-Buría
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain; Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
| | | | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain; Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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11
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Fernández-Sanchis D, Brandín-de la Cruz N, Jiménez-Sánchez C, Gil-Calvo M, Herrero P, Calvo S. Cost-Effectiveness of Upper Extremity Dry Needling in Chronic Stroke. Healthcare (Basel) 2022; 10:healthcare10010160. [PMID: 35052323 PMCID: PMC8775940 DOI: 10.3390/healthcare10010160] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/09/2022] [Accepted: 01/12/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction: Dry needling is a non-pharmacological approach that has proven to be effective in different neurological conditions. Objective: The aim of this study was to evaluate the cost-effectiveness of a single dry needling session in patients with chronic stroke. Methods: A cost-effectiveness analysis was performed based on a randomized controlled clinical trial. The results obtained from the values of the EuroQol-5D questionnaire and the Modified Modified Ashworth Scale were processed in order to obtain the percentage of treatment responders and the quality-adjusted life years (QALYs) for each alternative. The cost analysis was that of the hospital, clinic, or health center, including the equipment and physiotherapist. The cost per respondent and the incremental cost-effectiveness ratio of each alternative were assessed. Results: Twenty-three patients with stroke were selected. The cost of DN treatment was EUR 14.96, and the data analysis showed a favorable cost-effectiveness ratio of both EUR/QALY and EUR/responder for IG, although the sensitivity analysis using limit values did not confirm the dominance (higher effectiveness with less cost) of the dry needling over the sham dry needling. Conclusions: Dry needling is an affordable alternative with good results in the cost-effectiveness analysis—both immediately, and after two weeks of treatment—compared to sham dry needling in persons with chronic stroke.
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Affiliation(s)
- Daniel Fernández-Sanchis
- Faculty of Health Sciences, Universidad San Jorge, Autovía A-23 Zaragoza-Huesca Km.299, Villanueva de Gállego, 50830 Zaragoza, Spain; (D.F.-S.); (N.B.-d.l.C.); (C.J.-S.)
| | - Natalia Brandín-de la Cruz
- Faculty of Health Sciences, Universidad San Jorge, Autovía A-23 Zaragoza-Huesca Km.299, Villanueva de Gállego, 50830 Zaragoza, Spain; (D.F.-S.); (N.B.-d.l.C.); (C.J.-S.)
| | - Carolina Jiménez-Sánchez
- Faculty of Health Sciences, Universidad San Jorge, Autovía A-23 Zaragoza-Huesca Km.299, Villanueva de Gállego, 50830 Zaragoza, Spain; (D.F.-S.); (N.B.-d.l.C.); (C.J.-S.)
| | - Marina Gil-Calvo
- IIS Aragon, University of Zaragoza, Avda. San Juan Bosco, 13, 50009 Zaragoza, Spain; (M.G.-C.); (S.C.)
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, C/Domingo Miral s/n., 50009 Zaragoza, Spain
| | - Pablo Herrero
- IIS Aragon, University of Zaragoza, Avda. San Juan Bosco, 13, 50009 Zaragoza, Spain; (M.G.-C.); (S.C.)
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, C/Domingo Miral s/n., 50009 Zaragoza, Spain
- Correspondence:
| | - Sandra Calvo
- IIS Aragon, University of Zaragoza, Avda. San Juan Bosco, 13, 50009 Zaragoza, Spain; (M.G.-C.); (S.C.)
- Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, C/Domingo Miral s/n., 50009 Zaragoza, Spain
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12
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Calvo S, Brandín-de la Cruz N, Jiménez-Sánchez C, Bravo-Esteban E, Herrero P. Effects of dry needling on function, hypertonia and quality of life in chronic stroke: a randomized clinical trial. Acupunct Med 2021; 40:312-321. [PMID: 34894776 DOI: 10.1177/09645284211056347] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Persons with stroke commonly have impairments associated with a reduction in functionality. Motor impairments are the most prevalent, causing an impact on activities of daily life. OBJECTIVE The aim of this study was to evaluate the effect of a session of dry needling (DN) applied to the upper extremity muscles on the sensorimotor function, hypertonia, and quality of life of persons with chronic stroke. METHODS A randomized, sham-controlled clinical trial was performed. Participants were randomly assigned into an intervention group that received a single session DN in the biceps brachii, brachialis, flexor digitorum superficialis and profundus, extensor digitorum, adductor pollicis and triceps brachii muscles, or into a control group that received the same treatment but with a sham DN intervention. Treatment outcomes included the Fugl-Meyer Assessment Scale for the upper extremity, the Modified Modified Ashworth Scale, and the EuroQol-5D questionnaire. Measurements were carried out before, immediately after, and 14 days after intervention. RESULTS Twenty-three persons participated in the study. Significant differences between groups were observed after the intervention in the total wrist-hand motor score (p = 0.023) and sensorimotor score (p = 0.022), for hypertonia in the elbow extensors both after treatment (p = 0.002) and at follow-up (p = 0.018), and in quality of life at follow-up (p = 0.030). CONCLUSIONS A single session of DN improved total wrist-hand motor function and total sensorimotor function in persons with chronic stroke immediately after treatment, as well as quality of life 2 weeks after treatment. TRIAL REGISTRATION NUMBER NCT03546517 (ClinicalTrials.gov).
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Affiliation(s)
- Sandra Calvo
- IIS Aragon, Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
| | | | | | - Elisabeth Bravo-Esteban
- Faculty of Health Sciences, Universidad San Jorge, Zaragoza, Spain.,Toledo Physiotherapy Research Group (GIFTO), E.U.E. Fisioterapia de Toledo, Universidad Castilla La Mancha, Toledo, Spain
| | - Pablo Herrero
- IIS Aragon, Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
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13
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Fernández-de-Las-Peñas C, Plaza-Manzano G, Sanchez-Infante J, Gómez-Chiguano GF, Cleland JA, Arias-Buría JL, Navarro-Santana MJ. The importance of the local twitch response during needling interventions in spinal pain associated with myofascial trigger points: a systematic review and meta-analysis. Acupunct Med 2021; 40:299-311. [PMID: 34894759 DOI: 10.1177/09645284211056346] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To compare the clinical effects of needling interventions eliciting local twitch responses (LTRs) versus needling without eliciting LTRs when applied to muscle trigger points (TrPs) associated with spinal pain of musculoskeletal origin. DATABASES AND DATA TREATMENT Electronic databases were searched for randomized or non-randomized clinical trials where one group received needling intervention where LTRs were elicited and was compared with another group receiving the same intervention without elicitation of LTRs in spinal pain disorders associated with TrPs. Outcomes included pain intensity, pain-related disability, and pressure pain thresholds. The risk of bias (RoB) was assessed using the Cochrane risk of bias tool or ROBINS-I tool, methodological quality was assessed with the PEDro score, and quality of evidence was evaluated using the GRADE approach. RESULTS Six trials were included. The application of a needling intervention eliciting LTRs was associated with a significant reduction in pain intensity immediately after treatment (mean difference (MD): -2.03 points, 95% confidence interval (CI): -3.77 to -0.29; standardized MD (SMD): -1.35, 95% CI: -2.32 to -0.38, p = 0.02) when compared to the same needling intervention without elicitation of LTRs. No effect at short-term follow-up (MD: -0.20 points, 95% CI: -1.46 to 1.06, p = 0.75) was observed. No significant differences based on elicitation or non-elicitation of LTRs were found in related disability (SMD: -0.05, 95% CI: -0.41 to 0.30, p = 0.77) or pressure pain thresholds (MD: 23.39 kPa, 95% CI: -13.68 to 60.47, p = 0.22). DISCUSSION Low-level evidence suggests an immediate effect of obtaining LTRs during needling interventions on pain intensity, with no significant effects on related disability or pressure pain sensitivity in spinal pain disorders associated with muscle TrPs. REGISTRATION NUMBER OSF Registry-https://doi.org/10.17605/OSF.IO/5ZX9N.
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Affiliation(s)
- César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos (URJC), Alcorcón, Spain.,Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Jorge Sanchez-Infante
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, Toledo, Spain
| | - Guido F Gómez-Chiguano
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain.,Clínica Dinamia Fisioterapia. Madrid, Spain
| | - Joshua A Cleland
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - José L Arias-Buría
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos (URJC), Alcorcón, Spain.,Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Marcos J Navarro-Santana
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain.,Rehabilitación San Fernando, Madrid, Spain
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14
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Braithwaite FA, Walters JL, Moseley GL, Williams MT, McEvoy MP. A novel blinding protocol to test participant and therapist blinding during dry needling: a randomised controlled experiment. Physiotherapy 2021; 113:188-198. [PMID: 34579950 DOI: 10.1016/j.physio.2021.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 07/04/2021] [Accepted: 08/19/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Dry needling is widely used in physiotherapy. Lack of blinding in clinical trials means that dry needling effects and mechanisms remain unclear, with blinding issues accepted as an unavoidable barrier to better evidence. The authors aimed to overcome this barrier by designing a protocol to double-blind dry needling trials. DESIGN A prospectively registered randomised experiment tested a novel blinding protocol for blinding effectiveness. SETTING University physiotherapy clinic. PARTICIPANTS Therapists (n=15) and asymptomatic volunteers ('recipients') (n=45) were randomly allocated to real and/or sham interventions. INTERVENTIONS The protocol involved custom-made needles and cognitive and multisensory blinding techniques. MAIN OUTCOME MEASURES The primary outcome was guesses about allocation. The a priori criterion for successful blinding was ≤50% correct guesses (random chance). Secondary analyses explored blinding patterns using blinding indices. RESULTS Correct guesses were not different from 50% for therapists [41% (95%CI 30 to 50), n=120 guesses] or recipients [49% (95%CI 38 to 60), n=90 guesses]. Blinding indices supported the primary result but revealed that recipients were better at detecting real dry needling than sham. CONCLUSION Both therapists and recipients were successfully blinded, which contrasts with the widely held assumption that double-blinding is impossible for needling interventions. The authors recommend that any future trials can, and therefore should, blind therapists. However, secondary analyses revealed that recipients receiving real dry needling were less blinded than sham recipients, which may still create bias in clinical trials and suggests further work is needed to improve recipient blinding. Nonetheless, the current findings offer an opportunity to gain better evidence concerning the effects and mechanisms of dry needling. STUDY REGISTRATION https://osf.io/rkzeb/.
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Affiliation(s)
- Felicity A Braithwaite
- IIMPACT in Health, University of South Australia, GPO Box 2471, Adelaide 5001, South Australia, Australia.
| | - Julie L Walters
- IIMPACT in Health, University of South Australia, GPO Box 2471, Adelaide 5001, South Australia, Australia.
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, GPO Box 2471, Adelaide 5001, South Australia, Australia.
| | - Marie T Williams
- IIMPACT in Health, University of South Australia, GPO Box 2471, Adelaide 5001, South Australia, Australia.
| | - Maureen P McEvoy
- IIMPACT in Health, University of South Australia, GPO Box 2471, Adelaide 5001, South Australia, Australia.
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15
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Braithwaite FA, Walters JL, Moseley GL, Williams MT, McEvoy MP. A collaborative experiential problem-solving approach to develop shams for complex physical interventions: a case study of dry needling. Physiotherapy 2021; 113:177-187. [PMID: 34563384 DOI: 10.1016/j.physio.2021.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 07/04/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Complex physical interventions are widely used in physiotherapy, despite doubts over the validity of clinical trial results due to lack of credible shams. Credible shams are critically needed, so too, therefore, is a process by which they can be developed. The authors used a novel methodology to develop and test blinding protocols for dry needling, a complex physical intervention for which blinding is particularly difficult. DESIGN The research design was a practical three-day workshop influenced by Participatory Action Research, which uses iteration and reflection to solve a problem. PARTICIPANTS Five multidisciplinary experts (researchers, clinicians, technician, magician) were invited. Healthy volunteers ('recipients', n=17) and accredited physiotherapists (n=6) were recruited to enable testing of blinding strategies. MAIN OUTCOME MEASURES Primary outcomes were expert opinion on the potential to blind recipients/therapists for (1) individual blinding strategies, and (2) entire blinding protocols. Secondary outcomes included recipient/therapist blinding effectiveness and acceptability. RESULTS Experts iteratively developed 11 blinding protocols involving 22 blinding strategies. Experts rated 18 of the blinding strategies to 'definitely have potential' and identified four categories: knowledge of the sham, clinical interaction, disinformation, and sensation. Recipient and therapist blinding became more successful as the protocols evolved. CONCLUSIONS Credible shams capable of simultaneous recipient and therapist blinding have been regarded to be impossible in dry needling. The preliminary success of the devised protocols suggest that our novel approach may be a crucial step in sham development. Improvements in expert rankings and blinding effectiveness as the protocols progressed support the value of this workshop approach.
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Affiliation(s)
- Felicity A Braithwaite
- IIMPACT in Health, University of South Australia, GPO Box 2471, Adelaide 5001, South Australia, Australia.
| | - Julie L Walters
- IIMPACT in Health, University of South Australia, GPO Box 2471, Adelaide 5001, South Australia, Australia.
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, GPO Box 2471, Adelaide 5001, South Australia, Australia.
| | - Marie T Williams
- IIMPACT in Health, University of South Australia, GPO Box 2471, Adelaide 5001, South Australia, Australia.
| | - Maureen P McEvoy
- IIMPACT in Health, University of South Australia, GPO Box 2471, Adelaide 5001, South Australia, Australia.
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16
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Pourahmadi M, Dommerholt J, Fernández-de-Las-Peñas C, Koes BW, Mohseni-Bandpei MA, Mansournia MA, Delavari S, Keshtkar A, Bahramian M. Dry Needling for the Treatment of Tension-Type, Cervicogenic, or Migraine Headaches: A Systematic Review and Meta-Analysis. Phys Ther 2021; 101:6145044. [PMID: 33609358 DOI: 10.1093/ptj/pzab068] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/21/2020] [Accepted: 12/31/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Dry needling is a treatment technique used by clinicians to relieve symptoms in patients with tension-type headache (TTH), cervicogenic headache (CGH), or migraine. This systematic review's main objective was to assess the effectiveness of dry needling on headache pain intensity and related disability in patients with TTH, CGH, or migraine. METHODS Medline/PubMed, Scopus, Embase, PEDro, Web of Science, Ovid, Allied and Complementary Medicine Database/EBSCO, Cochrane Central Register of Controlled Clinical Trials, Google Scholar, and trial registries were searched until April 1, 2020, along with reference lists of eligible studies and related reviews. Randomized clinical trials or observational studies that compared the effectiveness of dry needling with any other interventions were eligible for inclusion. Three reviewers independently selected studies, extracted data, and assessed risk of bias. Random-effects meta-analyses were performed to produce pooled-effect estimates (Morris dppc2) and their respective CIs. RESULTS Of 2715 identified studies, 11 randomized clinical trials were eligible for qualitative synthesis and 9 for meta-analysis. Only 4 trials were of high quality. Very low-quality evidence suggested that dry needling is not statistically better than other interventions for improving headache pain intensity in the short term in patients with TTH (SMD -1.27, 95% CI = -3.56 to 1.03, n = 230), CGH (SMD -0.41, 95% CI = -4.69 to 3.87, n = 104), or mixed headache (TTH and migraine; SMD 0.03; 95% CI = -0.42 to 0.48, n = 90). Dry needling provided significantly greater improvement in related disability in the short term in patients with TTH (SMD -2.28, 95% CI = -2.66 to -1.91, n = 160) and CGH (SMD -0.72, 95% CI = -1.09 to -0.34, n = 144). The synthesis of results showed that dry needling could significantly improve headache frequency, health-related quality of life, trigger point tenderness, and cervical range of motion in TTH and CGH. CONCLUSIONS Dry needling produces similar effects to other interventions for short-term headache pain relief, whereas dry needling seems to be better than other therapies for improvement in related disability in the short term. IMPACT Although further high-methodological quality studies are warranted to provide a more robust conclusion, our systematic review suggested that for every 1 or 2 patients with TTH treated by dry needling, 1 patient will likely show decreased headache intensity (number needed to treat [NNT] = 2; large effect) and improved related disability (NNT = 1; very large effect). In CGH, for every 3 or 4 patients treated by dry needling, 1 patient will likely exhibit decreased headache intensity (NNT = 4; small effect) and improved related disability (NNT = 3; medium effect).
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Affiliation(s)
- Mohammadreza Pourahmadi
- Rehabilitation Research Center, Department of Physical Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Jan Dommerholt
- Bethesda Physiocare, Bethesda, Maryland, USA.,Myopain Seminars, Bethesda, Maryland, USA.,Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.,Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Bart Willem Koes
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.,Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | - Mohammad Ali Mohseni-Bandpei
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.,University Institute of Physical Therapy, Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Somayeh Delavari
- Center for Educational Research in Medical Sciences (CERMS), Department of Medical Education, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Abbasali Keshtkar
- Department of Health Sciences Education Development, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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17
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López-Royo MP, Ríos-Díaz J, Galán-Díaz RM, Herrero P, Gómez-Trullén EM. A Comparative Study of Treatment Interventions for Patellar Tendinopathy: A Randomized Controlled Trial. Arch Phys Med Rehabil 2021; 102:967-975. [PMID: 33556350 DOI: 10.1016/j.apmr.2021.01.073] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/28/2020] [Accepted: 01/16/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To determine the additional effect of dry needling (DN) or percutaneous needle electrolysis (PNE) combined with eccentric exercise (EE) and determine which is the most effective for patients with patellar tendinopathy (PT). DESIGN Blinded, randomized controlled trial, with follow-up at 10 and 22 weeks. SETTINGS Recruitment was performed in sport clubs. Diagnosis and intervention were conducted at San Jorge University. PARTICIPANTS Patients (N=48) with PT with pain for at least 3 months between the ages of 18 and 45 years. INTERVENTIONS Three interventions were carried out: DN and EE, PNE and EE, and EE with sham needle as the control group. MAIN OUTCOME MEASURES Disability was measured using the Victorian Institute of Sports Assessment Questionnaire, patellar tendon. Visual analog scale was used to measure pain over time, the Short Form-36 was used to measure quality of life, and ultrasound was used to measure structural abnormalities. RESULTS A total of 48 participants (42 men, 6 women; average age, 32.46y; SD, 7.14y) were enrolled. The improvement in disability and pain in each group between baseline and post-treatment and baseline and follow-up was significant (P≤.05), without differences among groups. CONCLUSION DN or PNE combined with an EE program has not shown to be more effective than a program of only EE to improve disability and pain in patients with PT in the short (10wk) and medium (22wk) terms. Clinical improvements were not associated with structural changes in the tendon.
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Affiliation(s)
- María Pilar López-Royo
- iPhysio Research Group, Universidad San Jorge, Villanueva de Gállego, Zaragoza, Spain; Universidad de Zaragoza, Faculty of Health Sciences, Zaragoza, Spain
| | - José Ríos-Díaz
- San Juan De Dios Foundation, Health Sciences University Centre, Antonio de Nebrija University, Madrid, Spain
| | - Rita María Galán-Díaz
- iPhysio Research Group, Universidad San Jorge, Villanueva de Gállego, Zaragoza, Spain
| | - Pablo Herrero
- Universidad de Zaragoza, Faculty of Health Sciences, Zaragoza, Spain.
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18
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Dommerholt J, Mayoral O, Thorp JN. A critical overview of the current myofascial pain literature - January 2021. J Bodyw Mov Ther 2021; 25:261-271. [PMID: 33714506 DOI: 10.1016/j.jbmt.2020.12.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Myofascial pain syndrome (MPS), trigger points (TrPs), and dry needling (DN) continue to be of interest to researchers and clinicians worldwide. In this quarterly overview, we included studies from 19 countries, including Pakistan, Iran, Spain, Israel, the US, Australia, Turkey, the UK, China, Italy, Germany, Brazil, Denmark, Canada, Saudi Arabia, Egypt, India, New Zealand, and Thailand. As encouraging as it may be that myofascial pain is being considered worldwide, it is frustrating how many studies do not include a proper control group making them not very useful. It is not clear why researchers would go through the trouble of setting up a study, which requires many hours of work and dedication, and not produce a meaningful paper for clinicians and researchers alike. Fortunately, several papers are high quality studies. This overview covers 39 basic research studies, systematic reviews and meta-analyses, clinical studies, and a few case reports.
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Affiliation(s)
- Jan Dommerholt
- Bethesda Physiocare, Bethesda, MD, USA; Myopain Seminars, Bethesda, MD, USA.
| | - Orlando Mayoral
- Physical Therapy Unit, Hospital Provincial de Toledo, Toledo, Spain; Seminarios Travell & Simons, Toledo, Spain.
| | - Jacob N Thorp
- Myopain Seminars, Bethesda, MD, USA; Charleston Southern University, North Charleston, SC, USA.
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19
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Braithwaite FA, Walters JL, Moseley GL, Williams MT, McEvoy MP. Towards more credible shams for physical interventions: A Delphi survey. Clin Trials 2020; 17:295-305. [PMID: 32153205 DOI: 10.1177/1740774520910365] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND/AIMS In clinical trials of physical interventions, participant blinding is often poorly addressed and therapist blinding routinely omitted. This situation presents a substantial barrier to moving the field forward. Improving the success of blinding will be a vital step towards determining the true mechanisms of physical interventions. We used a Delphi approach to identify important elements of shams for physical interventions to maximise the likelihood of participant and therapist blinding in clinical trials. METHODS Two expert groups were recruited: (1) experts in research methodology and (2) experts in deceptive and/or hypnotic techniques including magic. Magicians were included because they were considered a potentially rich source of innovation for developing credible shams due to their unique skills in altering perceptions and beliefs. Three rounds of survey were conducted, commencing with an open-ended question. Responses were converted to single 'items', which participants rated in the following two rounds using a 9-point Likert scale, categorised as 'Not important' (0-3), 'Depends' (4-6) and 'Essential' (7-9). Consensus was pre-defined as ≥80% agreement within a 3-point category. RESULTS Thirty-eight experts agreed to participate (research methodology: n = 22; deceptive and/or hypnotic techniques: n = 16), and 30 experts responded to at least one round (research methodology: n = 19; deceptive and/or hypnotic techniques: n = 11). Of 79 items, five reached consensus in the 'Essential' category in both groups, which related to beliefs of participants (n = 3 items), interactions with researchers (n = 1 item) and standardisation of clinical assessments (n = 1 item). Thirteen additional items reached consensus in the 'Essential' category in one group. Experts in research methodology had one additional item reach consensus, related to authentic delivery of study information. The remaining 12 additional items that reached consensus in the deceptive and/or hypnotic techniques group related mainly to therapist attitude and behaviour and the clinical interaction. CONCLUSION Experts agreed that, for shams to be believable, consideration of cognitive influences is essential. Contrary to the focus of previous shams for physical interventions, replicating the tactile sensation of the active treatment was not considered an essential part of sham development. Therefore, when designing sham-controlled clinical trials, researchers should carefully consider the cognitive credibility of the entire intervention experience, and not just the indistinguishability of the sham intervention itself. The findings provide new guidance to researchers on important contributors to blinding in physical intervention trials.
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Affiliation(s)
| | - Julie L Walters
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - G Lorimer Moseley
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Marie T Williams
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Maureen P McEvoy
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia
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